手指使用時における手関節の肢位とその変化 : 機能訓練および機能的副子における手関節の役割に関する考察

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The positional change of the wrist during activities using fingers is not precisely known. The lack of the control of the wrist could be one of the reasons why the quadriplegic patients are not actually using flexor hinge splints as expected. Minor attention to the role of the wrist in training the hemiplegic hands could make the affected hands less functional than potentially capable of. The purpose of this study is to provide some fundamental data regarding the functional adjustment of the wrist in the normal hand. 52 subjects volunteered. In Series I, discs of 5 different sizes, cylinderes of 3 different sizes, a pin and a card were transferred, rotated or turned on or between the various height. In Series II, 15 selected objects for the daily use were picked up, used and relocated. With use of the electrogoniometer developed for this study, the upper and lower terminal values (UTV, LTV) in extension-flexion plane of the wrist and the range of these two (U-L range) were measured for each task for each subject. The individual variation in each task demonstrated the normal distribution with the range of 40-50 degrees usually. Objects of ordinary sizes were transferred on the desk, with the wrist in sligth to moderate extension, demonstrating less than 10 degrees of U-L range. Thin, very small, very large or heavy objects located on the desk inclined the wrist position to flexion. Location of objects on higher horizontal plane or handling on the wall increased extension, usually without exceeding 65 degrees of extension. Consequently, the transfer task between planes of different height or different direction increased U-L range. Rotatory or turning task increased U-L range too, lowering LTV. Any tasks in Series II demonstrated the higher amount of U-L rane than simple transfer tasks on the desk in Series I. The amount of U-L ranges in use of selected objects for the daily use frequently exceeded the ones in single rotatory tasks or single transfer tasks between different planes, indicating the high frequency of the combination of these two factors in daily hand activities. The position of the wrist in the process of picking up selected objects for the daily use were quite similar to those of rotatory tasks in Series I. In use some tools, the position of the wrist was limited to only extension. However, many of selected objects for the daily use required the wide change of the wrist position including both flexion and extension. This was particularly so in objects handled on the surface of the body, such as a comb or toilet paper. For instance, in use of a pencil, the variation range demonstrated by 95% of subjects was [Ext. 15°-45°] in LTV, and [Ext. 30°-55°] in UTV, although in use of toilet paper, [Flex. 60°-25°] in LTV, and [Ext. 20°-60°] in UTV. In order that the position should not be deviated more than 3 standard deviations from the mean, the minimal dynamic range of the wrist was estimated to be Flex. 15°to Ext. 35°, (Flex. 25°to Ext. 40°in order to be within 2 standard deviations) allowing the associated finger movements.
1977-01-18

手指使用時における手関節の肢位とその変化 : 機能訓練および機能的副子における手関節の役割に関する考察

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